Pressor Effect of Water Drinking in Tetraplegic Patients May Be a Spinal Reflex
Pressor Effect of Water Drinking in Tetraplegic Patients May Be a Spinal Reflex
复制标题
四肢瘫痪患者喝水的升压作用可能是一种脊髓反射
作者：
J. Tank;C. Schroeder;M. Stoffels;A. Diedrich;Arya M. Sharma;F. Luft;J. Jordan
摘要：在自主神经功能衰竭的患者中，饮水引起了深刻的交感神经介导的升压反应。为了进一步阐明这种反应的机制，我们评估了饮用水对13名完全性脊髓损伤（C2至C7）四肢瘫痪患者（12名男性，1名女性; 39±4岁;体重指数，25±1 kg/m2）仰卧位血压和心率的急性影响。连续记录心率和手指血压。每5分钟测量一次肱动脉血压。压力感受性反射敏感性采用序贯法测定。通过使用经胸生物阻抗计算每搏输出量。患者取仰卧位，上身抬高15°。30分钟后，仰卧位患者摄入500 mL水，并监测随后的60分钟。基线时手指血压为123±8/65±4 mm Hg。饮水引起的升压反应在5 min内明显，35 ~ 40 min达最大值138±8/73±4 mmHg（P <0.05）。心率从基线时的64±2 bpm降至60±2 bpm（P <0.001）。肱动脉收缩压变化的平均曲线下面积与零有显著差异（364±151 mm Hg/min）。总外周阻力增加15±4%（P <0.05）。压力反射敏感性由饮水前的18±5 ms/mm Hg增加到饮水后35 min的23±6 ms/mm Hg（P <0.01）。即使脑干心血管中枢和脊髓交感神经元之间的直接联系中断，饮水也能引起升压反应。这一观察结果可能表明，饮水直接或通过脊髓反射机制激活节后交感神经元。
Abstract— Water drinking elicits a profound sympathetically mediated pressor response in patients with autonomic failure. To further elucidate the mechanism of the response, we assessed the acute effect of drinking water on supine blood pressure and heart rate in 13 tetraplegic patients (12 men, 1 woman; 39±4 years of age; body mass index, 25±1 kg/m2) with complete spinal cord injury (C2 to C7). Heart rate and finger blood pressure were recorded continuously. Brachial blood pressure was measured every 5 minutes. Baroreflex sensitivity was assessed by the sequence method. Stroke volume was calculated by use of transthoracic bioimpedance. Patients were placed in the supine position with the upper body elevated by 15°. After 30 minutes, supine patients ingested 500 mL of water and the following 60 minutes were monitored. Finger blood pressure at baseline was 123±8/65±4 mm Hg. Water drinking elicited a pressor response that was apparent within 5 minutes and reached a maximum of 138±8/73±4 mm Hg after 35 to 40 minutes (P <0.05). Heart rate decreased from 64±2 bpm at baseline to 60±2 bpm (P <0.001). The mean area under the curve for brachial systolic blood pressure changes differed significantly from zero (364±151 mm Hg/min). Total peripheral resistance increased by 15±4% (P <0.05). Baroreflex sensitivity increased from 18±5 ms/mm Hg at baseline to 23±6 ms/mm Hg at 35 minutes after water drinking (P <0.01). Water drinking elicits a pressor response even if the direct connection between brain stem cardiovascular centers and spinal sympathetic neurons is interrupted. This observation might suggest that water drinking activates postganglionic sympathetic neurons either directly or through a spinal reflex mechanism.
脊髓 NK1 受体在心血管对胆囊化学刺激的反应中的作用。
DOI：
10.1152/ajpheart.1995.268.2.h526
发表时间：
1995
期刊：
The American journal of physiology.
影响因子：
--
作者：
Pan,HL;Bonham,AC;Longhurst,JC
通讯作者：
Longhurst,JC